Comparative study of the analgesic profiles of a new intravenous paracetamol preparation, ketorolac, and their combination in day case otorhinolaryngologic surgeries

This study was done on 60 adult patients who had day case otorhinolarngologic surgeries. Patients were allocated into three groups, according to perioperative analgesic used: Group 1 [n =20] was given 30 mg ketorolac IV, Group 2 [n=20] was given a new solubilised paracetamol formulation [Perfalgan 10mg/mi] 1gm IV infusion, and Group 3 [n=20] was given 30mg ketorolac IV plus Perfalgan 1gm IV infusion. Analgesic profiles were evaluated using the sum of pain intensity difference after 6 and 12 hours of drug intake [SPID[6and12]], the total pain relief score after 6 and 12 hours of drug intake [TOTPAR[6and12]], global patient satisfactionwith pain control, and use of rescue analgesics. Surgeons' satisfaction with intraoperative bleeding and surgical field, in addition to bleeding time were also studied as indications of tolerability to the drugs. This study demonstrated no significant differences in pain scores between ketorolac and Perfalgan, while SPID[6and12] and TOTPAR[6and12] were significantly higher in the combination group [11.6 +/- 2.1 and 20.2 +/- 4.5, p=0.01 and 0.022 respectively for SPID[6and12] and 19.6 +/- 6.2 and 39.3 +/- 8.6, p=0.001 and 0.003 respectively for TOTPAR[6and12] indicating much less pain intensity and better pain relief with the combination. In addition, fewer patients in the combination group required rescue pethidine, while no significant difference was detected in the use of rescue pethidine between the other two groups. Fourteen patients in the combination group rated their satisfaction for the analgesic regimen as very good to excellent, while only one patient in the ketorolac group had a very good response, and none of the Perfalgan group had a very good to excellent response. Surgeons' satisfaction with intraoperative surgical bleeding and surgical field was satisfactory to excellent in all groups. In addition, postoperative bleeding times in all groups did not show any significant prolongation 12 hours after discharge from recovery room. This study has demonstrated that the use of a combination of paracetamol IV infusion in the new formulation known as 'Perfalgan' Ig and IV ketorolac 30mg for control of postoperative pain in day case otorhinologic surgeries was efficient and enough to avoid the use of additional narcotics, and had a better analgesic efficacy than either drug alone, without any significant side effects on intraoperative or postoperative surgical bleeding

Comparative study between Magnesium and dexmedetomidine as adjuvant to lidocaine for intravenous regional anesthesia

We conducted this study to evaluate the effects of magnesium and dexmedetomidine when added to lidocaine for intravenous regional anesthesia [IVRA]. Forty-five patients undergoing elective hand surgery during IVRA were randomly assigned to three groups. IVRA was achieved with 10ml of saline plus 3mg/kg lidocaine 0.5% diluted with saline to a total of 40ml in group L, 10ml of 10% magnesium sulfate plus 3mg/kg lidocaine 0.5% diluted with saline to a total of 40m1 in group M and 0.5micro g/kg dexmedetornidine plus 3mg/kg lidocaine 0.5% diluted with saline to a total close of 40ml in group D. Injection pain, sensory and motor block onset and recovery time, tourniquet pain, and anesthesia quality were noted, Patients were instructed to receive 75mg of IM diclofenac when the visual analog scale [VAS] score was >4, and analgesic requirements were recorded. Sensory and motor block onset times were shorter and recovery times were prolonged in group M and D. VAS scores of tourniquet pain were lower in group M and D at 15, 20, 30, 40 and 50mm [p<0.001]. Anesthesia quality, as determined by the anesthesiologist and surgeon, was better in group M and D [p<0.05]. Time to the first postoperative analgesic request was 95 +/- 29, l55 +/- 38, 170 +/- 20min in groups L, M, D respectively. There was a statistically difference in VAS scores for tourniquet pain at 15. 20, 30, 40 and 50min after tourniquet inflation [p<0.001]: VAS scores were lower in group M and D. Postoperative VAS scores were significantly higher for the first postoperative 6 hours in group L compared with group M [p<0.05]. In group D, postoperative VAS scores were significantly lower for the first postoperative 12 hours compared with group M and L. Diclofenac consumption was significantly less in group M [50 +/- 35mg] and group D [40 +/- 10mg] compared with group L [130 +/- 55mg] and in group D compared with group M [p<0.05]. No adverse effects were seen through the 24 hours postoperative period in the three groups. We conclude that magnesium and dexmedetomidine as an adjuncts, to lidocaine improves the quality of anesthesia and analgesia in IVRA, more in dexmedetomidine group

Comparative study between epidural verapamil and midazolam for postoperative analgesia in lower abdominal surgeries

Sixty patients ASA physical status I and II were studied. They were scheduled for elective short or moderate lower abdominal surgical procedures. They were randomly divided into three groups 20 patients each: gpI received 10ml bupivacaine 0.25% diluted in normal saline, gp II, received 0.05mg/kg midazolam and bupivacaine 0.25% in a total volume of 10ml. gp III, received 5mg verapamil, and bupivacaine 0.25% in a total volume of 10ml. All patients received standardized general anesthesia and the study drug was injected at the end of surgery. Routine monitorings were applied to all patients and lasted throughout the study period for the 1[st] 6 hours postoperative. Systolic, Diastolic blood pressure, HR were measured, the intensity of postoperative pain was assessed by VAS and the depth of sedation by the Observer's Assessment of Alertness/Sedation Score [OAA/S]. No significant changes in the hemodynamics occurred among groups, VAS showed significant decrease in gp II [bupivacaine. midazolam] 15mm after injection and lasted for shorter duration than the other 2 groups. OAA/S only changed in gp II patients. We concluded that epidural midazolam gives good postoperative analgesia with rapid onset but the accompanied sedation may limit early ambulation, on the other hand verapamil contributes to a better more prolonged postoperative analgesia devoid of sedation

Central venous catheters: peripheral versus central insertion in pediatric neurosurgical patients

Monitoring of central venous pressure [CVP] is widely used during surgery in order to guide fluid therapy. CVP in pediatric patients requires special skills and may be difficult especially in emergency conditions. This study was designed to investigate the advantages and disadvantages of both centrally and peripherally inserted central venous catheters. Fourty pediatric patients aged [4-12yrs] undergoing craniotomies for intracranial lesions were included in this study. Patients were randomly divided into 2 equal groups: Gp I [CICC] n=20 had centrally inserted central catheters in left or right internal jugular vein and gp II [PICC] n=20 had peripherally inserted central catheters through left or right antecubital veins. There was no statistically significant difference regarding catheter occlusion, dislodgment and time of insertion in both groups. Incidence of pneumothorax, hematoma and bacter-aemia was higher in CICC group compared to PICC group. Doppler detection of asymptomatic thromboses was equal in both groups. We concluded that PICC can be easily applied in pediatric neurosurgery with less hazards and more satisfaction either by the parents or the surgeons. Also Doppler screening for asymptomatic thromboses is recommended

Evaluation of respiratory functions in morbid obesity during laparoscopic and open surgery: a comparative study

Thirty morbidly obese patients, with body mass index [BMI] >40 kg/m2, ASA physical status II and III, were randomly divided into two equal groups, 15 patients each: GI [n = 15] was scheduled for laparoscopic surgery and GII [n = 15] was scheduled for open upper abdominal surgery. Their preoperative pulmonary function tests showed the following averages: FVC 85.10% +/- 3.21%, FEV1s 83.12% +/- 6.08% and FEF 25-75 was 88.76% +/- 7.22% of the normal predicated values [S0]. The spirometric data were repeated after 24 hr [S24] and 72 hr [S72]. Blood gas measurements during spontaneous respiration at room air before surgical intervention including an arterial oxygen tension [PaO2] of 76.49 +/- 7.64 mmHg, arterial carbon dioxide tension [PaCO2] of 37.73 +/- 2.04 and pH of 7.40 +/- 0.02. All measurements were performed with the patient in supine position at five time points. The measurements were arterial blood gases [ABG], alveolar-arterial oxygen difference calculated as an index of pulmonary shunt and arterial to end-tidal CO2 tension difference [delta P] calculated as an index of physiological dead space. The lung/chest wall compliance as well as the maximal and minimal resistance of the total respiratory system were investigated. In GI [laparoscopy], PaCO2, ETCO2, P [A-a] O2, alveolar-arterial oxygen difference and arterial to end-tidal CO2 tension difference and resistance showed a significant rise after CO2 peritoneal insufflation. All measurements returned to normal values by the end of surgery. In GII [open surgery], those measurements did not show any considerable change. The postoperative pulmonary functions showed a marked reduction in both groups but to a lesser degree in GI. However, GI returned to normal by the 3rd postoperative day